Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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Comparison of Effect of SSRIs and SNRIs on Depression, Pain and Somatic Symptoms in Elderly Patients with Major Depressive Disorder

노인 우울증 환자에서 선택적 세로토닌 재흡수 억제제, 세로토닌 노르에피네프린 재흡수 억제제가 우울증상, 통증 그리고 신체증상에 미치는 효과 비교

  • Han, Eun Hee (Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Hyun (Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Kang Joon (Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine)
  • 한은희 (인제대학교 의과대학 일산백병원 정신건강의학교실) ;
  • 김현 (인제대학교 의과대학 일산백병원 정신건강의학교실) ;
  • 이강준 (인제대학교 의과대학 일산백병원 정신건강의학교실)
  • Received : 2020.05.22
  • Accepted : 2020.06.23
  • Published : 2020.06.30
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Abstract

Objectives : The aim of this study was to compare the effect of Selective Serotonin Reuptake Inhibitor (SSRI) and Serotonin Norepinephrine Reuptake Inhibitor (SNRI) for mood symptoms, pain, and somatic symptoms in elderly depression patients with pain and somatic symptoms. Methods : This study is a prospective open-label study conducted by a single institution. A total of 43 subjects diagnosed with major depressive disorder under the DSM-5 diagnostic criteria participated in this study (average age: 72.53, 58.1% women). The subjects were classified as SSRI and SNRI groups. Depressive symptoms, pain, and somatic symptoms were evaluated by Korean version of the Hamilton Depression Rating Scale (K-HDRS), visual analogue scale (VAS) and Patient Health Questionnare-15 (PHQ-15) respectively at baseline and six weeks later. Two-way repeated-measure ANOVA was performed to analyze changes in the KHDRS, VAS, and PHQ-15 scores. Results : In the SSRI and SNRI groups, K-HDRS, VAS, and PHQ-15 all showed significant improvement after 6 weeks compared to each baseline values. There were no differences in therapeutic effect between the two groups. Conclusions : We found that SSRI and SNRI both improved somatic symptoms and pain in elderly depression patients. The results of this study are thought to help select antidepressants when administering medication to elderly depression patients who complain pain and somatic symptoms. Further research is needed on the longterm effects of the SSRI and SNRI.

연구목적 본 연구는 통증 및 신체증상이 동반된 노인 우울증 환자에서 기분증상 및 통증, 신체 증상에 대한 선택적 세로토닌 재흡수 억제제(Selective Serotonin Reuptake Inhibitor, SSRI)와 세로토닌 노르에피네프린 재흡수 억제제(Serotonin Norepinephrine Reuptake Inhibitor, SNRI)의 치료 효과를 비교하기 위해 실시되었다. 방 법 본 연구는 단일 기관에서 시행된 전향적 개방연구로 DSM-5 진단기준에 의해 주요우울장애로 진단받은 총 43명의 대상자들이 본 연구에 참여하였다(평균연령 : 72.53세, 여성 58.1%). 대상군은 SSRI, SNRI 두 군으로 분류되었고 우울, 통증 및 신체증상은 각각 한국판 해밀턴 우울증 평가척도(Korean version of the Hamilton Depression Rating Scale, K-HDRS), 시각적 비율 척도(Visual Analogue Scale, VAS), 환자 건강 설문지(Patient Health Questionnare-15, PHQ-15)를 사용하여 평가되었다. 이원배치 반복측정 분산분석(Two-way repeated-measure ANOVA)으로 약물 투여 전과 투여 후 6주의 KHDRS, VAS, PHQ-15 점수 변화를 분석하였다. 결 과 SSRI군과 SNRI군에서 K-HDRS, VAS, PHQ-15 모두 약물 투약 전에 비해 6주 후의 점수가 유의하게 호전되었으며, 두 군 간에 호전 정도의 차이는 없었다. 결 론 노인 우울증 환자에서 SSRI, SNRI 모두 통증 및 신체증상을 호전시키는 것으로 나타났다. 본 연구 결과는 통증 및 신체증상을 호소하는 노인 우울증 환자에게 약물치료를 시행할 때 선택할 수 있는 항우울제 처방 결정에 도움을 줄 수 있을 것이라고 생각되며, 약물의 장기적인 효과에 대해서 추가적인 연구가 필요할 것으로 보인다.

Keywords

References

  1. Statistical Office. Population and Housing Census Survey Sample Aggregation Results (Women, Children, Elderly People, etc.). Statistics Korea, 2015
  2. Birrer RB, Vemuri SP. Depression in later life: a diagnostic and therapeutic challenge. Am Fam Physician 2004;69:2375-2382.
  3. Cole MG, Dendukuri N. Risk factors for depression among elderly community subjects: systematic review and meta-analysis. Am J Psychiatry 2003;160:1147-1156. https://doi.org/10.1176/appi.ajp.160.6.1147
  4. Boswell EB, Stoudemire A. Major Depression in the primary care setting. Am J Med 1996;101:3S-9S.
  5. Health Insurance Policy Research Institute National Health Insurance Corporation [NHIC];2013.
  6. Hans PK. Somatic symptoms in depression. Dialogues Clin Neurosci 2006;8:227-239. https://doi.org/10.31887/DCNS.2006.8.2/hpkapfhammer
  7. Schappert SM. National Ambulatory Medical Care Survey, 991 Summary, 1994.
  8. Roh S, Park YC. Characteristics of depression in Korea and non-pharmacological treatment. Korean J Biol Psychiatry 2006;13:226-233.
  9. Kim Im. Elderly psychiatry. Edited by Min Sung-gil. The Latest Psychiatry 6th Edition. Seoul: Sculpture;2015. p.724-738.
  10. Yun KW, Kim SI. The influence of life stress on the severity of depression and somatic symptoms in depressive women. J Korean Neuropsychiatr Assoc 2010;49:304-311.
  11. Song JY, Park JC, Park JH, Oh DJ, Sohn HS, Chung KJ. Frequency and clinical characteristics of pain of the patients in psychiatric out-patient clinics. J Korean Neuropsychiatr Assoc 1999;38:1402-1411.
  12. Brodaty H, Harris L, Peters K, Wilhelm K, Hickie I, Boyce P, Mitchell P, Parker G, Eyers K. Prognosis of depression in the elderly. A comparison with younger patients. Br J Psychiatry 1993;163:589-596. https://doi.org/10.1192/bjp.163.5.589
  13. Gerber PD, Barrett JE, Barrett JA, Oxman TE, Manheimer E, Smith R, Whiting RD. The relationship of presenting physical complaints to depressive symptoms in primary care patients. J Gen Intern Med 1992;7:170-173. https://doi.org/10.1007/BF02598007
  14. Papakostas GI, Petersen T, Denninger J, Sonawalla SB, Mahal Y, Alpert JE, Nierenberg AA, Fava M. Somatic symptoms in treatment-resistant depression. Psychiatry Research 2003;118:39-45. https://doi.org/10.1016/S0165-1781(03)00063-5
  15. Alexopoulos GS. Pharmacotherapy for late-life depression. J Clin Psychiatry 2011;72:e04. https://doi.org/10.4088/JCP.7085tx2cj
  16. Solai LK, Mulsant BH, Pollock BG. Selective serotonin reuptake inhibitors for late-life depression. Drugs & Aging 2001;18:355-368. https://doi.org/10.2165/00002512-200118050-00006
  17. Cole MG, Elie LM, McCusker J, Bellavance F, Mansour A. Feasibility and effectiveness of treatments for post-stroke depression in elderly inpatients: systematic review. J Geriatr Psychiatry Neurol 2001;14:37-41. https://doi.org/10.1177/089198870101400109
  18. Cole MG. Feasibility and effectiveness of treatments for depression in elderly medical inpatients: a systematic review. Int Psychogeriatr 2000;12:453-461. https://doi.org/10.1017/S1041610200006578
  19. Mulsant BH, Pollock BG, Nebes RD, Miller MD, Little JT, Stack J, Houck PR. A double-blind randomized comparison of nortriptyline and paroxetine in the treatment of late-life depression: 6-week outcome. J Clin Psychiatry 1999;60:16-20.
  20. Bird H, Broggini M. Paroxetine versus amitriptyline for treatment of depression associated with rheumatoid arthritis: a randomized, double blind, parallel group study. J Rheumatol 2000;27:2791-2797.
  21. Emslie G, Judge R. Tricyclic antidepressants and selective serotonin reuptake inhibitors: use during pregnancy, in children/adolescents and in the elderly. Acta Psychiatrica Scandinavica 2000;101:26-34. https://doi.org/10.1111/j.1600-0447.2000.tb10945.x
  22. Arnold LM. Duloxetine and other antidepressants in the treatment of patients with fibromyalgia. Pain Medicine 2007;8:S63-S74. https://doi.org/10.1111/j.1526-4637.2006.00178.x
  23. Perahia DG, Pritchett YL, Desaiah D, Raskin J. Efficacy of duloxetine in painful symptoms: an analgesic or antidepressant effect? Int Clin Psychopharmacol 2006;21:311-317. https://doi.org/10.1097/01.yic.0000224782.83287.3c
  24. Pernia A, Mico J-A, Calderon E, Torres LM. Venlafaxine for the treatment of neuropathic pain. J Pain Symptom Manage 2000;19:408-410. https://doi.org/10.1016/S0885-3924(00)00151-2
  25. Max MB, Lynch SA, Muir J, Shoaf SE, Smoller B, Dubner R. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992;326:1250-1256. https://doi.org/10.1056/NEJM199205073261904
  26. Moon DE. Consideration of antidepressants in patients with chronic pain. J Korean Pain Soc 2004;17:S54-S62. https://doi.org/10.3344/kjp.2004.17.S.S54
  27. Arnold LM, Hess EV, Hudson JI, Berno SE, Keck PEA. Randomized, placebo-controlled, double-blind, flexible-dose study of fluoxetine in the treatment of women with fibromyalgia. Am J Med 2002;112:191-197. https://doi.org/10.1016/S0002-9343(01)01089-0
  28. Mallinckrodt CH, Prakash A, Houston JP, Swindle R, Detke MJ, Fava M. Differential antidepressant symptom efficacy: placebo-controlled comparisons of duloxetine and SSRIs (fluoxetine, paroxetine, escitalopram). Neuropsychobiology 2007;56:73-85. https://doi.org/10.1159/000111537
  29. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry Res 1960;23:56. https://doi.org/10.1136/jnnp.23.1.56
  30. Yi JS, Bae SO, Ahn YM, Park DB, Noh KS, Shin HK, Woo HW. Validity and Reliability of the Korean Version of the Hamilton Depression Rating Scale (K-Hdrs). J Korean Neuropsychiatr Assoc 2005;44:456-465.
  31. DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesthesia & Analgesia 1998;86:102-106. https://doi.org/10.1213/00000539-199801000-00020
  32. Kroenke K, Spitzer RL, Williams JB. The Phq-15: validity of a new measure for evaluating the severity of somatic symptoms. J Psychosom 2002;64:258-266. https://doi.org/10.1097/00006842-200203000-00008
  33. Han C, Pae CU, Patkar AA. Psychometric properties of the Patient Health Questionnaire-15 (PHQ-15) for measuring the somatic symptoms of psychiatric outpatients. Psychosom 2009;50:580-585. https://doi.org/10.1016/S0033-3182(09)70859-X
  34. Berger A, Dukes E, Edelnerg J, Stacey B, Oster G. Use of tricyclic antidepressants in older patients with diabetic peripheral neuropathy. Clin J Pain 2007;23:251-258. https://doi.org/10.1097/AJP.0b013e31802f67dd
  35. Sindrup SH, Jensen TS. Pharmacologic treatment of pain in polyneuropathy. Neurology 2000;55:915-920. https://doi.org/10.1212/WNL.55.7.915
  36. Lee SS. Diagnosis and treatment of fibromyalgia syndrome. The Korean J Med 2013;84:650-658. https://doi.org/10.3904/kjm.2013.84.5.650
  37. Hauser W, Thieme K, Turk DC. Guidelines on the management of fibromyalgia syndrome a systematic review. Eur J Pain 2010;11;505-521. https://doi.org/10.1016/j.jpain.2010.01.002
  38. Patkar AA, Masand PS, Krulewicz S, Mannelli P, Peindl K, Beebe KL. A randomized, controlled, trial of controlled release paroxetine in fibromyalgia. Am J Med 2007;120:448-454. https://doi.org/10.1016/j.amjmed.2006.06.006
  39. Anderberg UM, Marteinsdottir I, von Knorring L. Citalopram in patients with fibromyalgia--a randomized, doubleblind, placebo-controlled study. Eur J Pain 2000;4:27-35. https://doi.org/10.1053/eujp.1999.0148
  40. Otto M, Bach FW, Jensen TS, Brosen K, Sindrup SH. Escitalopram in painful polyneuropathy: a randomized, placebo- controlled, cross-over trial. Pain 2008;139:275-83. https://doi.org/10.1016/j.pain.2008.04.012
  41. Watson CPN, Evans RJ. The postmastectomy pain syndrome and topical capsaicin: a randomized trial. Pain 1992;51:375-379. https://doi.org/10.1016/0304-3959(92)90223-X
  42. Geisser ME, Roth RS, Robinson ME. Assessing depression among persons with chronic pain using the Center for Epidemiology Studies-Depression Scale and Beck Depression inventory: a compariative analysis. Clin J Pain 1997;13:163-170 https://doi.org/10.1097/00002508-199706000-00011
  43. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Archives of Internal Medicine 2003;163:2433-2445. https://doi.org/10.1001/archinte.163.20.2433
  44. Melzack R. Gate control theory: on the evolution of pain concepts. Pain Forum 1996;5:128-138. https://doi.org/10.1016/S1082-3174(96)80050-X
  45. Melzack R. From the gate to the neuromatrix. Pain 1999;82:S121-S126. https://doi.org/10.1016/S0304-3959(99)00145-1
  46. Campbell LC, Clauw DJ, Keefe FJ. Persistent pain and depression: a biopsychosocial perspective. Biol Psychiatry 2003;54:399-409. https://doi.org/10.1016/S0006-3223(03)00545-6
  47. D'Sa C, Duman RS. Antidepressants and neuroplasticity. Bipolar Disord 2002;4:183-194. https://doi.org/10.1034/j.1399-5618.2002.01203.x
  48. Lee AL, Ogle WO, Sapolsky RM. Stress and depression: possible links to neuron death in the hippocampus. Bipolar Disord 2002;4:117-128. https://doi.org/10.1034/j.1399-5618.2002.01144.x
  49. Mitchell BM, Sue AL, Joanne M, Susan ES. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992;326:1250-1256 https://doi.org/10.1056/NEJM199205073261904
  50. Engel CC, Walker EA, Engel AL, Bullis J, Armstrong A. A randomized, double-blind crossover trial of sertraline in women with chronic pelvic pain. J Psychosom Res 1998;44:203-207. https://doi.org/10.1016/S0022-3999(97)00215-8
  51. Mico JA, Ardid D, Berrocoso E, Eschalier A. Antidepressants and pain. Trends Pharmacol Sci 2006;27:348-354. https://doi.org/10.1016/j.tips.2006.05.004
  52. Tylee A, Gaspar M, Lepine JP, Mendlewicz J. DEPRES II. Depression Research in European Society II: a patient survey of the symptoms, disability and current management of depression in the community. DEPRES Steering Committee. Int J Psychopharmacol 1999;14:139-151.
  53. Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med 1999;341:1329-1335. https://doi.org/10.1056/NEJM199910283411801
  54. Denninger JW, Papakostas GI, Mahal Y, Merens W, Alpert JE, Nierenberg AA, Yeung A, Fava M. Somatic symptoms in outpatients with major depressive disorder treated with fluoxetine. Psychosom 2006;47:348-352. https://doi.org/10.1176/appi.psy.47.4.348
  55. Broekaert D, Gevers A, Janssens J. A double blind randomized placebo controlled crossover trial of citalopram, a selective 5-hydroxytryptamine reuptake inhibitor, in irritable bowel syndrome. Gastroenterology 2001;120:32-50.
  56. Kroenke K, Messina 3rd N, Benattia I, Graepel J, Musgnung J. Venlafaxine extended release in the short-term treatment of depressed and anxious primary care patients with multisomatoform disorder. J Clin Psychiatry 2006;67:72-80. https://doi.org/10.4088/JCP.v67n0111
  57. Hojo M, Miwa H, Yokoyama T, Ohkusa T, Nagahara A, Kawabe M, Asaoka D, Izumi Y, Sato N. Treatment of functional dyspepsia with antianxiety or antidepressive agents: systematic review. Journal of Gastroenterology 2005;40:1036-1042. https://doi.org/10.1007/s00535-005-1687-8
  58. Wu CY, Chou LT, Chen HP, Chang CS, Wong PG, Chen GH. Effect of fluoxetine on symptoms and gastric dysrhythmia in patients with functional dyspepsia. Hepato-Gastroenterology 2003;50:278-283.
  59. Herschbach P, Henrich G, von Rad M. Psychological factors in functional gastrointestinal disorders: characteristics of the disorder or of the illness behavior? Psychosom Med 1999;61:148-153. https://doi.org/10.1097/00006842-199903000-00005
  60. Hegeman JM, de Waal MW, Comijs HC, Kok RM, van der Mast RC. Depression in later life: a more somatic presentation? J Affect Disord 2015;170:196-202. https://doi.org/10.1016/j.jad.2014.08.032
  61. Wang YW, Lee CU. Pharmacological treatment of psychiatric disorders of the elderly. J Korean Med Assoc 2010;53:972-983 https://doi.org/10.5124/jkma.2010.53.11.972